Figure 1. Participation in the surveillance of SSIs, EU/EEA, 2013–2014

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European Surveillance of Surgical Site Infections and ICU-acquired Infections, Carl Suetens Surveillance Unit European Centre for Disease Prevention.

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Figure 1. Participation in the surveillance of SSIs, EU/EEA, 2013–2014 Source: Country reports from Austria, the Czech Republic, Estonia, Finland, France, Germany, Hungary, Italy, Lithuania, Malta, the Netherlands, Norway, Portugal, Romania, Slovakia and the United Kingdom (England, Northern Ireland, Scotland and Wales) Suggested citation: European Centre for Disease Prevention and Control. Annual epidemiological report 2015. Surgical site infections. Stockholm: ECDC; 2016. © European Centre for Disease Prevention and Control, 2016. Reproduction is authorised, provided the source is acknowledged

Number of reporting hospitals Table 1. Number of reporting hospitals and reported surgical procedures by country and type of operation, EU/EEA, 2013–2014 Country Number of reporting hospitals No. of CABG procedures No. of CHOL No. of COLO No. of CSEC No. of HPRO No. of KPRO procedures No. of LAM Total Patient-based data Austria 48 954 1 133 389 8 390 11 703 3 229 25 798 Estonia 1 304 469 773 Finland 13 13 712 11 642 25 354 France 345 1 159 18 010 7 649 28 936 31 465 10 387 2 417 100 023 Germany 845 24 955 33 955 16 800 39 093 102 209 51 863 8 010 276 885 Hungary 53 402 7 188 1 350 7 591 2 909 1 980 1 727 23 147 Italy 126 2 588 13 379 9 194 18 470 5 176 2 507 1 998 53 312 Lithuania 23 946 1 760 592 2 883 960 549 7 690 Malta 384 400 573 792 2 149 Netherlands 67 8 673 6 647 10 717 13 893 9 946 806 50 682 Norway 59 4 198 8 880 6 205 18 668 22 323 60 274 Portugal 37 49 5 509 3 006 3 400 3 031 2 357 1 070 18 422 Slovakia 8 1 145 UK–England 259 11 982 295 6 517 95 997 85 951 6 935 207 677 UK–Northern Ireland 11 11 420 3 609 2 795 804 18 628 UK–Wales 17 15 277 5 695 5 241 26 213 Subtotal 1 913 47 921 99 927 58 349 165 714 313 255 189 239 23 767 898 172 Unit-based data Czech Republic 566 Romania 254 2 695 2 116 653 17* 1087 6 822 UK–Scotland 33 33 179 16 494 11 958 61 631 42 2 682 33 759 16 511 1 087 69 019 EU/EEA 1 955 48 175 102 622 61 031 199 546 329 766 201 197 24 854 967 191 Source: Country reports from Austria, the Czech Republic, Estonia, Finland, France, Germany, Hungary, Italy, Lithuania, Malta, the Netherlands, Norway, Portugal, Romania, Slovakia and the United Kingdom (England, Northern Ireland, Scotland and Wales) * Excluded from further analysis because fewer than 20 surgical procedures of this type were reported by this country. CABG: coronary artery bypass graft, CHOL: cholecystectomy, COLO: colon surgery, CSEC: caesarean section, HPRO: hip prosthesis surgery, KPRO: knee prosthesis surgery, LAM: laminectomy Suggested citation: European Centre for Disease Prevention and Control. Annual epidemiological report 2015. Surgical site infections. Stockholm: ECDC; 2016. © European Centre for Disease Prevention and Control, 2016. Reproduction is authorised, provided the source is acknowledged

Table 2. Characteristics of patients by surgical procedure type, patient-based data, EU/EEA, 2013–2014 Characteristics CABG CHOL COLO CSEC HPRO KPRO LAM Surgical procedures (n) 47 921 99 927 58 349 165 714 313 255 189 239 23 767 Sex ratio (male:female) 4.0:1 0.6:1 1.0:1 0:1 1.1:1 Median age (years) 69 56 31 72 70 Post-operative in-hospital case fatality (%) 1.6 0.5 4.1 0.0 1.5 0.2 Contaminated or dirty operations (%) 15.4 30.4 6.3 1.3 0.7 0.9 Median duration of operation (minutes) 199 60 140 37 75 79 80 Median length of post-operative stay (days) 8 3 4 7 5 Urgent operations (%) 8.7 17.4 18.2 53.6 10.5 2.1 5.2 Antibiotic prophylaxis (%) 97.4 48.3 90.2 84.6 97.2 98.2 87.8 Source: Country reports from Austria, Estonia, Finland, France, Germany, Hungary, Italy, Lithuania, Malta, the Netherlands, Norway, Portugal, Slovakia and the United Kingdom (England, Northern Ireland and Wales). See Table 1 for reporting hospitals and reported surgical procedures in EU/EEA countries. CABG: coronary artery bypass graft, CHOL: cholecystectomy, COLO: colon surgery, CSEC: caesarean section, HPRO: hip prosthesis surgery, KPRO: knee prosthesis surgery, LAM: laminectomy Suggested citation: European Centre for Disease Prevention and Control. Annual epidemiological report 2015. Surgical site infections. Stockholm: ECDC; 2016. © European Centre for Disease Prevention and Control, 2016. Reproduction is authorised, provided the source is acknowledged

Figure 2. Number of reported SSI cases, EU/EEA, 2014 Source: Country reports from: Austria, the Czech Republic, Estonia, Finland, France, Germany, Hungary, Italy, Lithuania, Malta, the Netherlands, Norway, Portugal, Romania, Slovakia and the United Kingdom (England, Northern Ireland, Scotland and Wales). Suggested citation: European Centre for Disease Prevention and Control. Annual epidemiological report 2015. Surgical site infections. Stockholm: ECDC; 2016. © European Centre for Disease Prevention and Control, 2016. Reproduction is authorised, provided the source is acknowledged

Figure 3. Trends of percentage of SSIs by year and surgical procedure type, EU/EEA, 2011–2014 Source: Country reports from Austria, Czech Republic, Estonia, Finland, France, Germany, Hungary, Italy, Lithuania, Malta, Netherlands, Norway, Portugal, Romania, Slovakia and United Kingdom (England, Northern Ireland, Scotland and Wales). Suggested citation: European Centre for Disease Prevention and Control. Annual epidemiological report 2015. Surgical site infections. Stockholm: ECDC; 2016. © European Centre for Disease Prevention and Control, 2016. Reproduction is authorised, provided the source is acknowledged

Figure 4. Trends of incidence density of in-hospital SSIs by year and surgical procedure type, EU/EEA, 2011–2014 Source: Country reports from Austria, Czech Republic, Estonia, Finland, France, Germany, Hungary, Italy, Lithuania, Malta, Netherlands, Norway, Portugal, Romania, Slovakia and United Kingdom (England, Northern Ireland, Scotland and Wales). Note: Only SSIs diagnosed in-hospital were included. Suggested citation: European Centre for Disease Prevention and Control. Annual epidemiological report 2015. Surgical site infections. Stockholm: ECDC; 2016. © European Centre for Disease Prevention and Control, 2016. Reproduction is authorised, provided the source is acknowledged

Table 3. Percentages of microorganisms identified in SSIs by surgical procedure type, pooled data from 13 EU/EEA countries, 2013–2014 (n=9 858) Microorganisms CABG (n=1 059) CHOL (n=743) COLO (n=4 066) CSEC (n=528) HPRO (n=2 507) KPRO (n=814) LAM (n=141) Total (n=9 858) Gram-positive cocci 61.0 35.1 31.1 50.0 65.3 69.2 47.9 Staphylococcus aureus 19.4 9.8 4.3 25.8 30.8 34.4 29.1 17.0 Coagulase-negative staphylococci 33.2 2.8 2.1 10.0 18.8 22.7 18.4 12.1 Enterococcus species 7.6 21.9 7.2 11.3 6.3 9.2 15.2 Streptococcus species 0.3 3.0 2.4 5.7 3.5 3.8 Other Gram-positive cocci 0.5 0.1 1.3 1.0 2.0 0.7 Gram-positive bacilli 1.2 0.4 1.5 2.2 Gram-negative bacilli, Enterobacteriaceae 23.5 45.8 48.5 32.8 18.7 15.4 34.1 Escherichia coli 22.1 28.6 17.4 6.1 4.1 16.9 Citrobacter species 0.9 1.4 Enterobacter species 4.5 5.8 4.6 3.2 Klebsiella species 10.4 5.0 3.6 2.3 4.4 Proteus species 3.9 1.9 4.2 2.6 3.3 Serratia species 0.6 0.8 Other Enterobacteriaceae 2.7 Gram-negative non-fermentative bacilli 5.9 9.1 4.7 6.0 6.5 9.9 7.3 Acinetobacter species 0.2 Haemophilus species 0.0 Pseudomonas aeruginosa 7.8 8.5 Pseudomonadaceae family, other Stenotrophomonas maltophilia Other gram-negative non-fermentative bacilli Anaerobes 3.4 1.1 2.9 Bacteroides species 1.6 1.7 1.8 Other anaerobes Other bacteria 5.5 7.7 5.3 4.9 Fungi, parasites Candida species Other fungi or parasites Source: Country reports from the Czech Republic, Estonia, France, Germany, Hungary, Italy, Lithuania, Malta, the Netherlands, Portugal, Romania, Slovakia and the United Kingdom (England). Suggested citation: European Centre for Disease Prevention and Control. Annual epidemiological report 2015. Surgical site infections. Stockholm: ECDC; 2016. © European Centre for Disease Prevention and Control, 2016. Reproduction is authorised, provided the source is acknowledged

Table. Surgical site infections, surveillance systems overview, 2013–2014 Country Network name Surveillance option Post-discharge surveillance method Reporting period (ECDC) Reporting of national coverage data Austria Austrian Nosocomial Infection Surveillance System (ANISS) Patient-based None/Unknown 2009–2014 Not reported Czech Republic Czech HAI Network Unit-based ICSURG/REPSURG 2011–2014 Estonia Unknown 2012–2014 Finland Finnish Hospital Infection Programme (SIRO) ICGP/ICSURG/Readmission 2008–2014 2013–2014 France French HAI Early Warning, Investigation and Surveillance Network (Raisin) Germany German Nosocomial Infection Surveillance System (KISS Hungary National Nosocomial Surveillance System (NNSR) ICSURG/Readmission/Other Italy Sorveglianza Nazionale Infezioni in Chirurgia (SNICh) Infezioni Sito Chirurgico in Interventi di Artroprotesi (ISChIA) Infezioni del Sito Chirurgico-Gruppo Italiano di Studio di Igiene Ospedaliera (ISC-GISIO) ICPAT/Unknown Lithuania Institute of Hygiene Malta Mater Dei Hospital ICPAT Netherlands Prevention of Nosocomial Infection through Surveillance (PREZIES) Readmission Norway Norwegian Surveillance System for Antibiotic Consumption and Healthcare-associated Infections (NOIS) ICGP/ICPAT 2013 only Portugal Directorate-General of Health ICGP/ICPAT/ICSURG/ Readmission/REPSURG Romania National Institute of Public Health 2011–2013 Slovakia National Nosocomial Surveillance System (NNSS) 2014 only United Kingdom (England, Northern Ireland, Scotland and Wales) Surgical site infection surveillance service (SSISS) The Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) Welsh Healthcare Associated Infection Programme (WHAIP) Patient-based/unit-based England: Readmission; Northern Ireland: ICPAT/Readmission/Other/Unknown; Wales: Unknown; Scotland: Unknown Post-discharge surveillance methods: ICGP − Obtained by Infection Control (IC) staff from GP; ICPAT − Obtained by Infection Control (IC) staff from patient; ICSURG − Obtained by Infection Control (IC) staff from surgeon; Readmission – Detection at re-admission; REPGP – Reporting on GP’s initiative; REPPAT – Reporting on patient’s initiative; REPSURG – Reporting on surgeon’s initiative. Suggested citation: European Centre for Disease Prevention and Control. Annual epidemiological report 2016. Surgical site infections. Stockholm: ECDC; 2016. © European Centre for Disease Prevention and Control, 2016. Reproduction is authorised, provided the source is acknowledged